A Community Health Worker Program to Address Indoor Environmental Triggers for Childhood Asthma in East Harlem Public Housing: Implementation and Outcomes

Ray López1; Anne Bozack, MPH2; Tongtan Chantarat, MPH2; Linda Weiss, PhD2

1 Environmental Health & Family Asthma Program, LSA Family Health Service2 Center for Evaluation and Applied Research, The New York Academy of Medicine

Family Asthma Program

• Community Health Worker home visits focus on housing conditions and family habits that may affect a child’s asthma

• Services include:– Repeated CHW home visits over a 1 year period– Case management– Remediation to improve indoor air quality and

eliminate asthma triggers– Hands-on training for caregivers– Allergy control and pest management products– Tenant organizing and advocacy

CAHR – Controlling Asthma through Home Remediation

• Expansion of the Family Asthma Program • Funded HUD’s Office of Healthy Homes and Lead

Hazard Control• Families living in East Harlem public housing with

children 17 and under with severe or persistent asthma• Referrals from health care providers, asthma specialists,

and other community organizations • Evaluated by The New York Academy of Medicine

Housing Conditions Before

Housing Conditions Before

Remediation Process

Remediation Process

Remediation Process

Remediation Process

Remediation Process

Housing Conditions After

Housing Conditions After

• Evaluation measures- Changes in household condition- Changes in caregiver knowledge- Changes in child’s health- Resources for implementation

• Mixed methods utilizing- Assessments at baseline, 3, 6, and 12 months:

• CHW visual assessments of housing conditions• Caregiver surveys of housing conditions• Caregiver surveys of child’s health

- Caregiver satisfaction surveys and qualitative interviews- Program and administrative records

Evaluation Overview

Children (N = 152)n (%)

Age, Mean (SD) 8.34 (4.52)

GenderFemale 74 (48.7)Male 78 (51.3)

Race/EthnicityHispanic/Latino 74 (48.7)African American 52 (34.2)Mixed Race 16 (10.5)Other or unknown 10 (6.6)

Households (N = 98) n (%)Number of children enrolled per family

1 64 (65.3)2 22 (22.4)3 4 (4.1)4 8 (8.2)

Years at address, Mean (SD) 10.3 (9.25)

Baseline Characteristics

Asthma Symptoms

Baseline 3 - 7 months 10 - 15 months

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

3.313.06

3.42

3.583.28

1.92

Asthma symptoms in last 14 days (N = 36)

Days with symptoms Nighttime awakenings

Me

an

nu

mb

er

of d

ays

Baseline 3 - 7 months 10 - 15 months0

0.2

0.4

0.6

0.8

1

1.21.01

0.17

0.46

School absences due to symp-toms (days/school week in last

3 months) (N = 36)

Me

an

nu

mb

er

of a

bse

nce

s

Baseline 3 - 7 months 10 - 15 months0

1

2

3

4

5

6

7 6.25

4.69

3.58

Days of rescue medication use in last 14 days (N = 36)

Baseline 10 - 15 months0

0.5

1

1.5

2

2.5

3

3.5

4

4.53.86

1.39

0.440.22

Service use in last year (N = 36)

ER and urgent care visits Hospitalizations

Medication and Health Care Use

Housing Conditions

Dust Mold Clutter Cockroaches Mice0

5

10

15

20

25

30

Moderate or Severe Conditions Observed by CHW (N = 37)

BaselineOne year

Advocacy

• Quarterly meetings with NYCHA & residents known to LSA to address repairs.

• Co-chair of NYCAP’s Environment Committee− Template letter for physicians− Know Your Housing Rights

• “Breathless” Documentary on Dateline NBC

NYCHA v. Baez Settlement

Americans with Disability Act

• December 2012: Request for Accommodation• June 2013: Negotiations with NYCHA• December 2013: Reached Settlement• April 2014: Settlement Certified by judge• May 2014: Implementation begins

Discussion• Unique program characteristics

- Implemented by CHWs- In-home remediation and training

There’s a difference between briefing you and actually sitting you down and showing you what you’re supposed to do…I like the hands-on.

- Advocacy

I had to go into Housing court and they helped out. I wouldn’t have gotten a lot of things done [without] the letters that [the EHW] wrote to me.

Discussion• Challenges

- Difficulty reaching referral targets- Referred families residing in private housing (not eligible)- Engaging families and following-up with families

• Structural deficiencies limit environmental improvements: policy changes are critical for program success

• Limitations- No control group- Effects of NYCHA settlement not known

• Sustainability - Need for CHW services to be reimbursable

Contact Information

Ray López, DirectorEnvironmental Health & Family Asthma ProgramLittle Sisters of the Assumption Family Health Servicerlopez@lsafhs.org(646) 672-5233

Anne Bozack, MPH, Project DirectorCenter for Evaluation and Applied ResearchNew York Academy of Medicineabozack@nyam.org212-822-7253